Well-being among elderly community Well-being among elderly community dwellers and assisted living residents: dwellers and assisted living residents:
A comparative analysisA comparative analysis
Sara Carmel, Hava Tovel, Zinovi ShragaSara Carmel, Hava Tovel, Zinovi ShragaThe Center for Multidisciplinary Research in AgingThe Center for Multidisciplinary Research in Aging
Faculty of Health SciencesFaculty of Health Sciences
Ben-Gurion University of the NegevBen-Gurion University of the Negev
Supported by: The Israel Ministry for Senior Citizens
The Abraham and Sonia Rochlin FoundationThe Abraham and Sonia Rochlin Foundation
Quality of life and subjective well-being – Quality of life and subjective well-being – societal needs and challengessocietal needs and challenges
Decreased quality of life is one of the Decreased quality of life is one of the phenomena accompanying prolonged life, phenomena accompanying prolonged life, with significant implications for the elderly, with significant implications for the elderly, their families, and society as a whole.their families, and society as a whole.
Finding the best social solutions for this Finding the best social solutions for this relatively vulnerable population group has relatively vulnerable population group has become a challenge to all nations. become a challenge to all nations.
Purpose of the studyPurpose of the study
The leading worldwide approach for maintaining successful aging is to enable older people to "age in place" – in their homes and communities.
The purpose of this study was to question this dominant approach by comparing subjective well-being (SWB) of assisted-living residents (ALR) to that of community dwellers (CD).
Assisted living (AL) in IsraelAssisted living (AL) in Israel
In Israel, AL sites (also called “sheltered housing”) In Israel, AL sites (also called “sheltered housing”) are run by for-profit and non-profit organizations.are run by for-profit and non-profit organizations.
Both provide high quality services.Both provide high quality services.
(165 sites/21,000 units)(165 sites/21,000 units)
Services provided: Services provided: - Personal safety arrangements Personal safety arrangements - 24-hour availability of medical services24-hour availability of medical services- Immediate assistance for any needImmediate assistance for any need- Restaurant servicesRestaurant services- Home cleaning and repairsHome cleaning and repairs- A variety of social, cultural and physical activitiesA variety of social, cultural and physical activities
The degree of use of each service depends on the residentThe degree of use of each service depends on the resident. .
Method
Structured home interviews were conducted with two groups of people aged 75+, living in 3 major Israeli cities - Tel-Aviv, Beer-Sheva, Haifa.
1. An ALR group, based on agreement to participate in the study from 8 large facilities (n=215)
2. A CD group - of elderly matched for age, gender, family status, economic status, ADL, and IADL (n=215)
Comparison between CD and ALR on health, function, Comparison between CD and ALR on health, function, and socio-demographic characteristicsand socio-demographic characteristics
CDALRt 2 df pGenderMaleFemaleMaleFemale2 =.30, df=1, p=.58
59 (27%)156 (73%)54 (35%)161(75%)
Spouseyesnoyesno2 =1.66, df=1, p=.198
80 )37%(
135 (63%)67 )31%(
147 (69%)
Age (M/SD)83.9 (4.19)83.9 (5.38)t=-.100, df=428, p=.920
Health (M/SD)3.13 (.94)3.09 (.84)t= .515, df=428, p=.607
IADL (M/SD)1.39.) 55(1.33.) 55(t=1.25, df=426, p=.211
EducationlowHighlowHigh
15 )7%(
98 )46%
(
101 )47%
(
21 )10%
(
78 )37%
(
114 )53%
(
Economic status
BadgoodVery good
badgoodVery good
2 =4.85, df=2, p=.089
16 )7%(
171)80%
(
28 )13%
(
16 )7%(
154 )72%
(
45 )21%
(
Comparison between CD and ALR on indicators of SWBComparison between CD and ALR on indicators of SWB
Well-beingCD M (SD)
ALRM (SD)
t
Life satisfaction (Neugarten)3.45.) 68(3.65.) 61(-3.24 ,p=.001
Life satisfaction (Carmel)3.96.) 66(4.17.) 55(-3.57 ,p<.000
Successful aging (subjective)7.58) 1.83(8.03) 1.62(-2.65 ,p=.008
Loneliness (high score = low loneliness)4.71) 1.25(5.03) 1.12(-2.72 ,p=.007
Happiness5.29) 1.26(5.50) 1.03(-1.85 ,p=.064
Morale (Lawton et al.)2.85.) 64(2.96.) 52(-2.21 ,p=.032
Will to live3.43.) 88(3.43.) 72(.105 ,p=.920
GDS (high score = low depression) 11.18) 3.42(11.96) 2.99(-2.53 ,p=.012
Fear of dying3.72) 1.19(4.04) 1.12(-2.86 ,p=.004
Fear of death1.55.) 81(1.38.) 63(2.37 ,p=.018
Antecedents of different aspects of well-being (Antecedents of different aspects of well-being ())
LS-NLS-CSuccess-ful aging
Loneli-ness
Happin-ness
Morale
Will to live
GDSFear of dying
Fear of
death
Gender.099*.119**.108*.146*.053.041.-089.067.142*.-023
Spouse.-167**.-124*.-059.-228**.-058.-086.-067.-110*.-081.-063
Econo. status
.139**.146*.079.045.083.080.-014.069.-083.072
Health status
.-331**.-313**.-358**.-125*.-266**.-398**.-291**.-247**.185**.073
IADL.-134**.-146**.-149**.-095.-054.-121*.-025.-246**.-146*.088
Resid-ence
.138**.150**.109**.137**.080.082.-004.104*.143**.-100*
R2.26**.25**.24**.11**.11**.26**.10**.22**.08**.02*
LS-N – Life satisfaction (Neugarten et al., 1961) , LS-C – Life Satisfaction Carmel, 1997Morale – Philadelphia Geriatric Center Moral Scale (Lawton, 1975), Loneliness – Hughes et al. , 2004,Happiness – Lyubomirsky et al., 1999 ,
GDS – Geriatric Depression Scale (Zalsman et al., 1998).
Addressed needs and satisfaction in ALAddressed needs and satisfaction in AL
Degree of addressed needs in AL Degree of addressed needs in AL (on a scale of 0-5)(on a scale of 0-5): :
A high degree of response to needs with average A high degree of response to needs with average scores from 4.84 (SD= .44) to 4.34 (SD=1.38) . scores from 4.84 (SD= .44) to 4.34 (SD=1.38) . Exception – reference to meals (3.00, SD=2.2) due to Exception – reference to meals (3.00, SD=2.2) due to great variability in use.great variability in use.
The highest scores were given for: ability to manage an The highest scores were given for: ability to manage an independent life, to continue life as usual, feeling independent life, to continue life as usual, feeling comfortable in the apartment, physical security, comfortable in the apartment, physical security, accessibility of medical services, and privacy. accessibility of medical services, and privacy.
Satisfaction with relocation to AL was high – Satisfaction with relocation to AL was high –
87% responded as very satisfied87% responded as very satisfied..
Experienced changes in AL
What are the 3 most important changes for you with relocation?(% out of all responses in each category)
Positive (202 out of 215 responded – 365 responses): - Social life - 29% - Release from household- Personal security - 22% duties - 7%- Leisure activities - 13% - Easier life - 7%- Personal tranquility - 9% - Medical security - 5%
- Housing conditions - 5% Negative (83 out of 215-responded, 23 responded - no negative change,
altogether only 49 responses): - Condition of neighbors 22% - - Adjustment difficulties - 10% - Housing conditions - 22% - Loss of neighborhood - 10% - Loss of privacy - 8% - Faraway from town - 6% - Lacking pets - 4% - Other issues - 16%
Summary of resultsSummary of results The two groups were similar in socio-demographic
characteristics, self-rated health, ADL, and IADL.
ALR ranked themselves significantly and systematically higher than CD on indicators of well-being including: Satisfaction with life (two measures) Self-perceived successful aging Happiness Morale Fear of death (inverse direction) Depression (inverse direction) Loneliness (inverse direction) (8 out of 10)
ALR ranked themselves worse regarding fear of dying.
In
Summary of results (cont.)Summary of results (cont.)
The best predictors of SWB across 10 different measures, in order of importance, were:
- self-evaluated health status- type of residence- IADL- gender - having a spouse - self-evaluated economic status.
Most of the responses to needs addressed in AL and changes with relocation indicated a high level of satisfaction with relocation
ConclusionsConclusions Type of residence plays an important role in influencing
older adults' SWB, assisted living being preferable.
The residence effect is stronger than age, gender, economic status, having a spouse, and IADL.
These findings and their practical implications shatter the currently dominant beliefs and practices regarding best residence solutions for elderly people.
Replications of this study in Israel and other countries are needed in order to ascertain these findings and the derived implications.
We must continuously promote evidence-based best responses to the needs of older adults and society.
Life is Life is
beautifulbeautiful
Comparison between CD and ALR on indicators of SWBComparison between CD and ALR on indicators of SWB
Men only Men only (n=113)(n=113)Well-beingCD
M/SDALR
M/SDt
Life satisfaction (Neugarten)3.41.) 71(3.70.) 59(-2.32 ,p=.022
Life satisfaction (Carmel)3.93.)73(4.18.) 55(-2.06 ,p<.041
Successful Aging (subjective)7.43) 1.83(8.04) 1.72(-1.69 ,p=.093
Loneliness (high score = low loneliness)4.50) 1.35(5.11) 1.11(-2.59 ,p=.011
Happiness5.21) 1.32(5.60) 1.16(-1.64 ,p=.103
Morale (Lawton et al.)2.89.) 70(3.01.) 50(-1.00 ,p=.318
Will to live3.56.) 82(3.64.) 54(.-650 ,p=.517
GDS (high score = low depression) 11.17) 3.84(12.26) 2.75(-1.75 ,p=.084
Fear of dying3.72) 1.19(4.04) 1.12(-2.16 ,p=.033
Fear of death1.51.) 70(1.46.) 74(.380 ,p=.705
Comparison between CD and AR on indicators of SWBComparison between CD and AR on indicators of SWBWomen only, n=317Women only, n=317
Well-beingCDM/SD
ALRM/SD
t
Life satisfaction (Neugarten)3.46.) 67(3.63.)61(-2.37 ,p=.018
Life satisfaction (Carmel)3.97.) 63(4.16.) 56(-2.89 ,p<.004
Successful Aging (subjective)7.64) 1.74(8.02) 1.60(-2.04 ,p=.042
Loneliness (high score = low loneliness)4.80) 1.21(5.00) 1.13(-1.56 ,p=.121
Happiness5.32) 1.25(5.46) 1.00(-1.13 ,p=.260
Morale (Lawton et al.)2.84.) 61(2.97.) 53(-1.93 ,p=.054
Will to live3.39.) 89(3.36.) 77(.366 ,p=.714
GDS (high score = low depression) 11.18) 3.26(11.86) 3.01(-1.91 ,p=.057
Fear of dying3.85)1.16(4.11) 1.11(-1.94 ,p=.053
Fear of death1.56.) 86(1.35.) 59(2.49 ,p=.013